| Background:In today’s society,many people are facing such problems as too much psychological pressure,emotional tension and anxiety.People in China and around the world are more or less suffering from mental illness.To deal with this problem correctly,prevention and treatment is the key.As early as 1992,World Mental Health Day was launched by the World Psychiatric Association(WPA)on October 10 every year.On September 10,1996,the Ministry of Health issued the Notice on the Promotion and Education of World Mental Health Day 1996(No.79 of Health Care and Health Facility 1996),requesting all parts of the country to carry out various promotional activities of World Mental Health Day.However,due to the limited popularity of knowledge and treatment methods related to mental illness,many patients have misunderstandings in the choice of treatment methods.Early psychiatric patients(course of disease is 1-3 years)can be treated by medication,at this time,if the medication can play a better curative effect can maintain treatment.If the treatment of refractory psychiatric disorders(course of disease is 3-5 years or more),through drugs,electrical stimulation,psychological counseling and other treatment are ineffective,surgical minimally invasive surgery is recommended.In the history of world medicine,the origins of the idea of micro-invention can be traced back to the ancient Greek philosopher Dr.Hippocrates,who mentioned more than 2,000 years ago that medical activities must first be as small as possible,otherwise the damage caused by treatment may be more serious than the disease itself.Minimally invasive surgery,such as laparoscopic,has become a major trend in clinical surgery with the rapid development of science and technology,and can also be used to treat neurosurgery diseases with minor inj uries in the field of neurosurgery.Stereotactic brain lesion surgery is one of the minimally invasive surgical methods which have been widely used in clinic in recent years.It has the advantage of less invasion to the brain.At the same time,with the maturity of imaging methods such as MRI and cranial CT,the safety of surgery has been improved significantly.After treatment,most patients’symptoms have been improved or the dosage of drugs can be reduced significantly.However,after all,as a kind of invasive surgery,the impact on patients is relatively large.In addition,the operation of such patients is difficult and the operation is very easy to cause cardiac dysfunction.There are still some risks in the operation.Therefore,the choice of safe anesthesia and suitable anesthetic drugs have significant clinical significance.Generally,general anesthesia is used in clinic,and it is feared that the patients will wake up immediately after the operation and will not cooperate with restlessness to cause hemodynamic instability and cerebral hemorrhage.Therefore,after the operation,they will choose to let the patients resume spontaneous breathing under shallow anesthesia,and then send the tracheal intubation to ICU for sedation observation after a period of time to make the patients awake and pull out.In addition to tracheal intubation.Therefore,how to restore spontaneous breathing quickly and prevent cough and restlessness under the condition of shallow anesthesia with tracheal intubation is very important to maintain the stability of hemodynamics.Dexmedetomidine(Dex),as a new type of drug,is an A2 adrenergic receptor agonist with high selectivity.Dex can activate A2 adrenergic receptors in locus coeruleus and spinal cord,exert sedative and anti-anxiety effects,and has significant analgesic effects.Many studies at home and abroad have proved that intraoperative infusion of dexmedetomidine has a significant effect in reducing the incidence of restlessness during recovery and maintaining respiratory and circulatory stability during recovery.The pharmacological effect of dexmedetomidine is the best anesthetic effect for patients undergoing stereotactic brain lesion during recovery period.Objective:This study mainly explores whether the patients of right metamorphic stereotactic surgery can reduce the incidence of restlessness and changes in stress response when recovering autonomic breathing in the state of postoperative shallow anaesthetic with trachea catheter.Method:Based on the inclusion and exclusion criteria,80 patients with schizophrenia who needed stereotactic brain lesion surgery in our hospital from March 2018 to March 2019 were selected and randomly divided into two groups(n=40),namely saline control group(group C)and dexmedetomidine experimental group(group D).All patients were given routine vital signs monitoring,rapid induction anesthesia and endotracheal intubation assisted by visual laryngoscope after entering the room.The depth of endotracheal catheter was confirmed to be appropriate.The respiratory parameters were adjusted to maintain PETCO2 between 35 and 45 mmHg.After fixing the endotracheal catheter,left radial artery puncture and catheterization were performed to continuously monitor arterial blood pressure.Intravenous inhalation combined with anesthesia was used for maintenance.In group D,dexmedetomidine was slowly pumped 1.Oug/kg before induction of anesthesia for 10 minutes,and 0.5ug/(kg.h)was continuously pumped into ICU during the operation.In group C,0.9%sodium chloride(NaCl)was injected to replace Dex to ICU.The changes of mean arterial pressure(MAP),heart rate(HR)and electroencephalogram(BIS)at each time point before anesthesia induction(T0),5 minutes after tracheal intubation(T1),top bracket(T2),scalp incision(T3),end of operation(T4),recovery of spontaneous breathing(T5),30 minutes after ICU(T6)were recorded.Comparing the general condition of the two groups of patients,the restlessness score(SAS score)of the recovery time(T5)at the moment of recovery at the end of the operation and the sedative score(Ramsay score)of the patients who were 30min after transfer to the ICU(Ramsay score).Blood pumping at T0,T4,T6 time monitoring stress indicators:blood sugar(Glu),epinephrine(E),serum cortisol(COR),norepinephrine(NE)changes.Result:1.Comparisons of general conditions between the two groups:There was no significant difference in general condition between the two groups(P>0.05).2.Comparison of restlessness score and respiratory recovery time during recovery period:Compared with the control group,the restlessness score of the observation group decreased significantly at T5 and T6 time points(P<0.05).There was no significant difference in respiratory recovery time between the two groups(P>0.05).3.Comparison of mean arterial pressure,heart rate and BIS values:There was no significant difference in mean arterial pressure,heart rate and BIS between the two groups at T0 and T4(P>0.05).At T1,T2,T3,T5 and T6,the changes of mean arterial pressure,heart rate and BIS in the experimental group were significantly better than those in the control group(P<0.05).4.Comparison of the patient’s sedation score(Ramsay score)when entering ICU30min(T6)and the incidence of respiratory suppression and cough at this time:Ramsay scores significantly and the incidence of respiratory suppression and cough at this time better than the control group in the T6 point-in-time group,with a statistically significant difference(P<0.05).5.T0,T4,T6 moment stress indicators:Glu,E,COR,NE changes compared:There was no significant difference in the levels of Glu,E,COR and NE between the two groups at T0(P>0.05),but the levels of Glu,E,COR and NE in the experimental group were significantly higher than those in the control group at T4 and T6(P<0.05).Conclusion:Pumping dexmedetomidine can significantly reduce the agitation and stress response after general anesthesia in psychiatric patients undergoing stereotactic destruction of the brain. |
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